<!DOCTYPE html>
<html>
  <head>
    <meta charset="UTF-8">
    <title></title>
  </head>
  <body>
    <form action="http://www.google.com/" method="post">
      <label for="fl">姓名:</label> <input type="text" id="fl"><br>
      <label for="cm">公司:</label> <input type="text" id="cm"><br>
      <label for="a1">地址:</label> <input type="text" id="a1"><br>
      <label for="a2">地址2:</label> <input type="text" id="a2"><br>
      <label for="ct">市:</label> <input type="text" id="ct"><br>
      <label for="zc">邮编:</label> <input type="text" id="zc"><br>
      <label for="st">省:</label> <input type="text" id="st"><br>
      <label for="em">邮箱:</label> <input type="text" id="em"><br>
      <label for="ph">电话:</label> <input type="text" id="ph"><br>
      <label for="c1">持卡人姓名：</label> <input type="text" id="c1"><br>
      <label for="c2">信用卡号码：</label> <input type="text" id="c2"><br>
      <label for="c3">月：</label> <input type="text" id="c3"><br>
      <label for="c4">年：</label> <input type="text" id="c4"><br>
    </form>
  </body>
</html>